A Manifesto for Ecological Healing: Valuing Traditional Knowledge in Mozambique

Abstract

Mozambican traditional healing is a longstanding, community-embedded practice grounded in local knowledge systems and biodiversity. Despite its resilience, it has been persistently marginalized—from colonial impositions to enduring legal ambiguities—while Western medicine, rooted in Hippocratic, Galenic, and Cartesian paradigms, has become the normative model. This article explores the ethical, legal, and consequentialist dimensions of emancipating traditional healing, analyzing four policy options: prohibition, indifference, protection, and encouragement. Emancipation is presented not as subordination to biomedical standards but as a process of epistemic justice, affirming cultural sovereignty and community agency. Core values such as justice, equity, and respect for plural worldviews underpin the discussion. Traditional healers are often spiritually mandated and serve over 80% of the population, particularly in underserved areas, yet remain institutionally undervalued. Promoting respectful dialogue among stakeholders is crucial to avoid reductive adaptations and foster inclusive, sustainable health systems. Recognizing traditional healing as a legitimate and complementary system not only strengthens Mozambique’s National Health System (SNS) but also contributes to achieving the Sustainable Development Goals (SDGs) related to health, inclusion, and cultural rights. This article argues that empowering traditional healing is both a moral imperative and a strategic investment in planetary health and human flourishing.

1. Introduction

Mozambican traditional healing comprises generational practices rooted in the use of biodiversity and local epistemologies, frequently intertwined with spiritual beliefs and rituals. It remains particularly vital in the central and northern regions, where the National Health System continues to face persistent constraints [1,2]. The country possesses a remarkable wealth of medicinal plants, many of which have been documented [3,4,5]. Audet et al. [6] note that traditional healers are often the first point of contact for patients, offering psychosocial support, health education, and treatment for a wide range of conditions. In addition, Sitoe and Van Wyk [7] catalogued 731 medicinal species used for various ailments, while other ethnobotanical surveys have identified plants with specific efficacy against bacterial and parasitic diseases [8,9,10]. These findings, drawn from different regions and health challenges, illustrate the breadth of conditions addressed by traditional healing and the way its impact may vary according to local resources, cultural frameworks, and possibly the severity of illness—a theme explored in greater depth later in this paper.

Owing to Mozambique’s considerable cultural and ecological diversity [6], traditional healing is inherently heterogeneous. Ethnobotanical surveys [1,3] have revealed region-specific therapeutic repertoires, while historical botanical missions [5] and authoritative compendia of medicinal plants [11] illustrate that certain remedies are unique to specific provinces. Policy reports [12] further recognize the complexity of integrating such varied practices into a coherent national healthcare framework. Even for comparable disease categories, the choice of plants, methods of preparation, and associated spiritual frameworks may differ substantially from north to south. Nevertheless, several of the issues discussed remain relevant beyond Mozambique, offering insights applicable to traditional healing systems in other parts of the world.

Similar situations to that of Mozambique occur in various national contexts. In Southern Africa, South Africa has explored the role of traditional healers in post-apartheid health policies. At the same time, countries such as Zambia, Uganda, Botswana, Malawi, and the Central African Republic have involved these practitioners in HIV/AIDS education and counselling programs [13,14]. Outside the region, traditional medicine remains widely used to meet primary care needs in several countries in Africa, Asia, and Latin America [15]. Brazil, for example, combines Indigenous, African, and European practices, facing similar cultural and institutional integration challenges [16].

Appreciating traditional healing requires suspending dominant, often colonial or globalized, epistemologies. Urban skepticism, shaped by mechanistic paradigms, tends to marginalize holistic worldviews [12]. Such bias is reinforced by the demand for validation standards of the mainstream biomedical establishment, as imposed by bodies such as the FDA or recommended by the WHO, despite centuries of empirical use.

Traditional healing has long ensured public health, well before the influence of colonial or Arab powers [17], Its role must be seen beyond merely filling gaps left by modern systems. Terminologies like “traditional healing” are reductive, overlooking its philosophical, mystical, and sociopolitical roles [18]. Its forced translation into colonial frameworks distorted its meaning and undermined its legitimacy.

Western terms such as “sorcerer” or “witch” often carry derogatory connotations rooted in colonial and medieval stigmas [19], contributing to the alienation of traditional practitioners. The fervor of the “witch hunt” left indelible consequences in the European imagination, a feeling that marginalized the guardians of native African science without granting them the benefit of the doubt. Now, many people are afraid to approach the so-called traditional healers—or equivalents—seeing them as summoners of demonic forces capable of selling their souls to the devil of the Abrahamic religions.

Modern medicine, though seen as universal, draws heavily from Greco-Roman traditions and global contributions, such as those by Avicenna [20]. The symbol of Asclepius and the Hippocratic Oath reflect this lineage. Figures like Galen or Paracelsus, once foundational, would today be labeled “alternative,” illustrating how institutional standards evolve. Yet, modern systems now require rigid licensing, excluding other knowledge systems.

Although the ethical dimensions of African traditional healing are highly relevant, they remain under-researched. The few authors who have addressed the subject generally concur on the need for more integrative healthcare systems that combine biomedicine with traditional, alternative, and complementary healing practices. For instance, Ewuoso et al. [21], in South Africa, analyzed ethics and moral issues in traditional bone-healing from the perspective of the African philosophy called ubuntu, focused on extreme empathy as healing one person equates to healing the entire community. Akpuogwu et al. [22] discussed how normative ethics apply to traditional healing in Africa as a whole. These studies are valuable contributions, but it is still essential to shed some light on what normative ethics has to say about traditional healing within the African countries, because the differences are expected considering the countries’ diverse cultural and environmental features. Even within Mozambique, for example, there are ten agroecological zones [23] and 18 sociolinguistic groups [24].

This essay advocates for the ethical and cultural emancipation of traditional healing, acknowledging it as a vital yet undervalued pillar for national development and planetary health. Five decades after independence, Mozambique still hesitates to recognize the legitimacy of traditional healing [11] entirely. Such silence reflects deep discomfort with distinct worldviews and practices. It urges a respectful integration of ancestral wisdom with future innovation. Section 2 describes in detail the methodological approach guiding this analysis.

2. Review Methodology

The methodology adopted mirrors that of a previous study on the ethical implications of a corruption case [25]. This analysis of the ethical dilemma surrounding traditional Mozambican healing was conducted through a theoretical framework grounded in normative ethics, specifically the deontological, virtue, and consequentialist approaches, with a particular focus on utilitarianism. The objective was to critically assess ethical alternatives concerning the integration or marginalisation of traditional medicine in the Mozambican context.

The research was based on documentary investigation, using keywords such as “traditional healing,” “Mozambique,” “ethics,” “integration,” “justice,” “equity,” and “emancipation” (including their Portuguese equivalents). As “traditional medicine” is also a common term for traditional healing, it was included as a search keyword. Searches were conducted on Google Scholar (https://scholar.google.com/, accessed on 10 September 2024) with the following inclusion criteria: publications in Portuguese or English, published between 1998 and 2024, focused on the Mozambican or African context, and explicitly addressing the relationship between ethics and traditional practices or dilemmas in traditional healing. Publications lacking a critical analysis of the interaction between traditional healing and biomedicine were excluded.

An initial screening identified 65 sources, including scientific articles, books, official documents, and other relevant materials. After applying the selection criteria, 32 sources were retained: 18 scientific articles, 7 books, and 7 institutional documents, reports, or videos.

Table 1. The 10 most relevant sources found in the literature.

No.	Year	Source Type	Theme	Main Topic	Reference
1	1990	Book chapter	Ethnobotany	Traditional uses	Jansen et al. [11]
2	1998	Book	Health policy	Integration of traditional healing into healthcare	da Silva [2]
3	2001	Journal article	Ethnobotany	African ethnobotany with a focus on Mozambique	Bandeira et al. [3]
4	2013	Journal article	Public health	Educational intervention and healer referrals to allopathic care	Audet et al. [6]
5	2014	Journal article	Ethnobotany	Flora medicinal documentation (1942–1948)	Conde et al. [5]
6	2016	Journal article	Ethnobotany	Turning traditional into scientific knowledge	Agostinho [26]
7	2022	Journal article	Public health	Disease management from a traditional perspective	Nhaueleque [1]
8	2023	Journal article	Ethnobotany	Sesamum alatum uses and ecology	Cambaza [4]
9	2024	Newspaper article	Health policy	Emancipation of traditional healing	Borges [27]
10	2024	Journal article	Ethnobotany	Inventory and analysis of medicinal plants of Mozambique	Sitoe and Van Wyk [7]

shows the 10 primary sources.

These were coded in Atlas.ti 9.1.7 [28] was used to analyze data using thematic categories such as “social justice,” “equity,” “emancipation,” “ethics in medicine,” “cultural conflict,” “integration of traditional practices,” and “health policies.” The coding process allowed systematic organisation of the material, forming the structural basis for the analysis according to the proposed outline.

As the writing progressed, additional sources were incorporated to strengthen the discussion, particularly regarding the four identified ethical alternatives: prohibition, indifference, defensive intervention, and proactive encouragement. Each alternative was examined through the lens of different ethical theories, with special attention to the principles of justice and equity.

Overall, the methodology maintained a consistent dialogue between ethical theory and practical health realities in Mozambique, underscoring the central role of traditional healing in cultural diversity and its potential to reinforce the National Health System. The final analysis emphasised the need for inclusive engagement among all stakeholders as a prerequisite for the ethical emancipation of traditional healing in alignment with core moral values.

3. Framing the Epistemic Conflict

Biomedicine evolved from Greco-Roman and Judeo-Christian traditions, later shaped by industrialization, colonialism, and globalization into a reductionist, mechanistic system. Vandana Shiva [29] criticizes biomedicine for prioritizing profit over humanistic values and accuses it of participating in epistemic neocolonialism, in contrast to systems like Ayurveda.

Biomedicine was introduced during colonial rule without adapting to local conceptions of health, creating a persistent dissonance with indigenous worldviews grounded in communal experience and intuition [26,30]. Colonial interest in local knowledge was limited to extractable benefits, such as pharmacological compounds, excluding their symbolic and sociopolitical meaning.

Traditional healing, deeply embedded in Mozambican culture, integrates plant-based therapies with spiritual and sociopolitical dimensions. Although medicinal plants are a central part of this healing tradition, other practices, such as the use of therapeutic techniques, have been ignored. Ethnobotany, along with its spiritual and sociopolitical roles, should not be dissociated, as this could lead to a less comprehensive understanding when observed through predominantly Western epistemologies. For example, the traditional healer is primarily viewed as a caregiver, but their role is not limited to healing; they often act as priests, counselors, or community leaders. Given their widespread use [27], these practices merit formal recognition for their multifaceted contributions to public health and community resilience.

Traditional healing has endured despite opposition from various sectors, including religious, political, and biomedical. For example, Samora Machel [31] denounced superstition, reflecting Marxist and Judeo-Christian influences that still marginalize African spiritualities. Despite formal efforts, such as the Traditional Healing Policy [6,14], concerns persist regarding tokenism and the lack of genuine integration. Evaluating traditional healing solely through Western biomedical lenses perpetuates bias and frames it as incomplete. This bias, described by Fricker [32] as ‘testimonial injustice,’ can in extreme cases contribute to what de Sousa Santos [33] terms “epistemicide.” Each system should be assessed within its epistemology, as one cannot judge diverse health systems using a single normative framework.

Traditional healing is widely practiced across Mozambique, but its social dynamics vary by socioeconomic class. In underdeveloped communities, it remains a primary and trusted source of healthcare due to accessibility, cultural alignment, and flexible payment arrangements [34,35]. In higher socioeconomic and more highly educated groups, however, its use often occurs discreetly due to fear of religious or social stigma, and typically when biomedical care fails to resolve a problem—echoing historical cases such as Rasputin and the Russian imperial family. Wealthier Mozambicans are also more likely to seek foreign healthcare, such as in South Africa. They may turn to imported “alternative” systems like Ayurveda or acupuncture, which are perceived as globally fashionable, rather than “traditional.” Nevertheless, studies suggest that up to 70% of both elite and non-elite populations in Africa engage with traditional healing at some point [34], reflecting its persistent holistic appeal across class lines [36,37], even as it remains marginalized within Western medical frameworks [38].

4. Main Stakeholders

Of all the stakeholders, the most directly involved are Traditional healers, who sustain themselves through a practice often perceived as a spiritual duty, as Miraculous Majane explained in a VOA Português interview [39]. Their motivation stems from a perceived spiritual calling and community responsibility (see Section 8 for details).

As we have already begun to discuss the conventional doctor, he can now be presented as the second interested party. Biomedicine, one of the most prestigious fields globally, has contributed to population growth and public health [23]. Physicians are trained to restore health through evidence-based interventions that are aligned with institutional protocols. In this reflection, it is pertinent to consider that tensions between biomedical and traditional practitioners often arise from competition for legitimacy and patient trust, grounded in perceptions of scientific authority—examples of collaboration mechanisms are addressed in Section 5. Although many biomedical professionals are spiritual or religious, their work is guided by pragmatic, measurable outcomes, which contrasts with the holistic and symbolic nature of traditional healing. While biomedicine emphasizes standardization and objectivity, traditional healing integrates artistic, philosophical, and spiritual dimensions.

The population is the primary beneficiary—or victim—of tensions between the two systems. They benefit when competition improves care, but suffer when it leads to confusion and mistrust. Discrediting traditional healers may erode their broader role as community anchors, potentially causing local instability. In some cases, the population may reject state authorities in defense of healers they trust, highlighting the importance of mutual legitimacy.

Another interested party, also mentioned above, is the State. The State must ensure harmony among diverse cultural groups by adopting inclusive, participatory policies that respect traditional health practices. Mozambique is a secular State, but its population is significantly religious. Despite constitutional neutrality, the legacy of Marxist-Leninist policy [17] and imported religious worldviews still influence attitudes towards traditional healing. The ideological diversity within state institutions reflects that of the broader society, meaning policies may be inconsistently applied depending on individual beliefs and values.

5. Integration of Traditional Healing, Biomedical Practice, and Policy in Mozambique

Building on this reliance [2,6,27], this section focuses on mechanisms for clinical and policy integration between traditional healing and biomedicine. Following global health directives, Mozambique has implemented formal measures to incorporate traditional medicine into its health system. The establishment of AMETRAMO in 1990 [12,27] granted legal status to traditional healers and positioned the association as an intermediary between practitioners and the state. The Traditional Medicine Policy [12] sets out regulatory, training, and collaboration goals, alongside commitments to protect intellectual property and promote equitable benefit-sharing from plant-based remedies [3,5] (for legal analysis, see the Section 8). These frameworks also emphasise the role of research institutions dedicated to medicinal plants [26], urging that such knowledge be preserved within its full sociocultural context rather than reduced to isolated chemical analyses.

On the clinical side, integration requires sustained dialogue and mutual respect [6,39]. Existing referral pathways—typically from healers to biomedical facilities—could be expanded to allow two-way cooperation. Training initiatives can enable healers to adopt safe biomedical procedures (e.g., sterilisation, management of adverse effects) without undermining their cultural foundations [6,40]. In contrast, biomedical practitioners benefit from understanding patients’ explanatory models of illness [1,18]. In certain conditions, such as infertility or chronic pain, both approaches may offer complementary benefits, addressing physical, spiritual, and social dimensions concurrently. However, progress remains constrained by enduring structural and attitudinal barriers. Historical stigmas (see Section 3 for origins) still influence some biomedical professionals. Regulatory frameworks sometimes limit combined treatments, as in restrictions on concurrent use of herbal and antiretroviral therapies [6]. Methodological difficulties arise in validating diverse traditional practices through conventional clinical trials, and as detailed in the Section 6 concerns persist over safety and quality assurance [27]. Patients’ reluctance to disclose traditional remedy use to biomedical staff—often due to fear of disapproval—further hampers safe, coordinated care [21] (

Table 2. Most positive and arguable impacts of traditional healing and biomedicine in Mozambique, highlighting their respective strengths, limitations, and areas of contention.

Approach	Positive Impacts	Challenges and Controversies
Traditional Healing	Cultural alignment and accessibility—Trusted by ~80% of Mozambicans, especially in rural areas, offering care in local languages and within shared cosmological frameworks [2,6,27,41]. Holistic approach—Addresses social, spiritual, ecological, and physical aspects of illness, seeking to restore harmony [1,3,42]. Condition-specific effectiveness. Psychosocial support—Provides counseling, stigma reduction, and health education adapted to poverty contexts [6,41].	Regulatory and safety issues—Lack of dosage standardization, risk of harmful interactions with biomedical drugs, and occasional reports of toxicity or deaths [27]. Stigma and association with witchcraft—Historical colonial and religious prejudice undermines legitimacy [17,30,43,44]. Variable quality control—Presence of unqualified practitioners can damage trust [27]; Cost variability—Some treatments may exceed biomedical consultation costs [27].
Biomedicine	Scientific basis and precision—Uses evidence-based diagnostics and validated treatments [25]; Efficacy in acute or critical care—Highly effective for surgical interventions, infections, and life-threatening conditions. Public health reach—National Health System provides vaccination, antiretroviral therapy (ART), and emergency care [25,45]. Standardization—Ensures reproducibility and universal protocols [25].	Cultural disconnect—Often disregards patients’ spiritual or ancestral illness explanations, harming adherence [21]. Reductionist approach—Focuses narrowly on biological aspects, ignoring social and spiritual dimensions [18]. Access barriers—Long wait times, staff shortages, and rural service gaps [45]; Hegemonic attitudes—Tends to marginalize local knowledge and undervalue healers as health partners [30].

).

6. Ethical Tensions and Foundational Values

At the heart of this debate lies the respect for human dignity, regardless of worldview or profession. Interactions between traditional healers, biomedical practitioners, and policymakers must reflect mutual recognition and cultural sensitivity. The right to health choice is enshrined in Articles 2, 18, and 19 of the Universal Declaration of Human Rights [26]. Citizens must be free to choose how they care for their health, including traditional methods, without facing discrimination or prejudice.

Traditional healing often evokes mistrust in biomedical circles due to its spiritual and symbolic nature. In contrast, the biomedical system is rooted in transparency, objectivity, and accountability. These epistemological differences fuel mutual misunderstanding. While traditional practices are sometimes perceived as opaque or esoteric, dismissing them without engagement reinforces entrenched prejudice.

To the biomedical clinician, traditional healing often seems like an unpredictable and undefined element, the black sheep that he tries to understand at all costs but cannot, or the Joker in a deck of cards. Thus, the conventional physician sees the traditional as that person who has followed an obscure path to reach an intellectual destination that resembles his own but is not really, and in his conception, artisanal and primitive. This is because the idea that his extensive training process can have an equivalence outside mainstream science does not fit into his thinking. Thus, the values of the conventional doctor are deeply linked to his ethics and professional code of conduct. From his perspective, it is, in fact, only a doctor who has mastery of such values.

Trust is essential. Without institutional frameworks, traditional healing is more vulnerable to fraud and misinformation, as seen globally during the COVID-19 crisis [46]. Impostors posing as traditional healers have eroded the credibility of legitimate practitioners, contributing to widespread distrust of the field. Recent efforts, including new normative frameworks and departmental initiatives at the Ministry of Health, aim to enhance legitimacy, trust, and collaboration between the traditional and biomedical sectors.

Justice and equity demand that traditional healers receive recognition and protection equivalent to other health professionals. This aligns with the earlier discussion on dismantling structural bias, but here the focus shifts to concrete policy measures for equitable treatment. They must not be relegated to peripheral roles or treated merely as referral agents. Policy decisions should involve individuals who understand both traditional and biomedical systems of care, as well as those who are knowledgeable about both. The morality of traditional healers stems from their spiritual obligations and cultural roles [2], rather than from Western ethical codes. While legal compliance is necessary, their moral compass is often internalized through ancestral accountability.

Reconciling diverse epistemologies and moral systems is essential for planetary health and sustainable development. Respecting traditional healing as a valid system of care fosters cultural justice, community empowerment, and plural approaches to human flourishing.

7. Alternatives

There are several policy approaches to the professional and ethical recognition of traditional healing in Mozambique—these range from prohibition to full institutional promotion. The following section outlines four main alternatives, highlighting their ethical, social, and practical implications.

Some argue for banning traditional healing due to perceived physical or moral risks. Critics point to spiritual explanations for diseases like HIV/AIDS as harmful delays in biomedical treatment. Cases of fraud and superstition also fuel this view. However, banning an entire system due to the actions of a few risks erasing legitimate practitioners and Mozambican cultural heritage. Regulatory approaches—such as building databases on plant toxicity—could offer safer alternatives. Moreover, prohibition may drive practices underground, increasing mystery, risk, and mistrust. The global rejection of COVID Organics from Madagascar, despite its botanical basis [47], illustrates how traditional innovations can face double standards.

Indifference may seem aligned with freedom of choice, requiring no policy or oversight. Yet, in contexts of historical inequality and stigma, neutrality often reinforces structural injustice. Many users of traditional healing services remain silent due to fear of judgment [19]. Passive tolerance may preserve the practice, but does not ensure safety, dignity, or fairness. Moreover, perceived state inaction can provoke resistance from biomedical professionals or religious groups, further polarizing the debate and threatening public cohesion.

A middle-ground approach is defensive protection—intervening only when traditional healers face threats or discrimination. This recognizes their status as citizens and cultural agents but provides limited structural support. Professions typically thrive when formally recognized, resourced, and integrated into systems of training and regulation. While institutions such as AMETRAMO and CIDE [26] have emerged, their impact remains limited. Stronger cross-disciplinary research and inclusive collaboration between traditional and biomedical practitioners are needed to address misconceptions and promote equity [2].

Proactive encouragement involves public education, stigma reduction, and institutional integration. Since the population already values traditional healing, the focus should be on dignifying it. Efforts should prioritize cultural literacy, mutual respect, and support for traditional epistemologies. Concepts such as Ubuntu illustrate how traditional worldviews promote holistic health, where spiritual and physical realms are connected [48]. Dialogue between healers and academics can foster better understanding and improve communication with the public. With appropriate platforms and safeguards, traditional healing can be demystified and valued as a contributor to sustainability, planetary health, and human flourishing.

The path forward requires a balanced combination of recognition, regulation, and respectful integration. Proactive strategies that preserve cultural heritage while safeguarding public health can make a significant contribution to achieving the SDGs.

8. The Ethics of the Emancipation

The ethical evaluation of traditional healing’s emancipation can be framed through three normative approaches (

Table 3. Matrix of ethics of alternatives for the emancipation of traditional Mozambican healing.

Criterion	Forbid	Ignore (Truce)	Protect	Encourage
Legality	Articles 2 and 5 of Ministerial Diploma No. 78/92 of 10 June 1992 are prohibitive	It is a favorable environment, but there are articles 2 and 5 of Ministerial Diploma No. 78/92 of 10 June 1992 that are prohibitive	There is a permissive environment: Traditional Healing Policy; Existence of official institutions.	There is a permissive environment: (1) Traditional Healing Policy; (2) The existence of official institutions.
Virtuosity or justice	Violates the freedom of beliefs and practices of traditional healers	It is not beneficial because it favors existing structural violence	Beneficial and fair	Beneficial and fair
Utility	It deprives the benefit of healing to 80% of the population	Allows practice but does not prevent discrimination	Allows the preservation of traditional healing, where it is possible to intervene	Offers accessibility of healing to at least 80% of the population
Conclusion	It is a threat to Mozambican cultural heritage	In favor of perpetuating structural violence against traditional healers	It dignifies the traditional healer, but is unlikely to promote equity	Considering the limitations of the SNS, it is the best alternative in favor of the third SDG (health and well-being for all)

)—legal, moral, and consequentialist—each offering insights into how best to ensure dignity, justice, and sustainability in public health. Although the table presents a good summary, providing an overview of the potential ethical implications, it is essential to discuss each perspective of normative ethics in greater depth, substantiating it with relevant examples and reflections.

Traditional healing predates Mozambique’s sovereignty and formal legal system. Colonial-era legislation explicitly banned spiritual and ethnomedical practices under labels like “witchcraft” or “divination” (e.g., Decree-Law No. 23/1933; Decree-Law No. 32/171/1942). However, Mozambique has since recognized traditional healing through the Traditional Healing Policy [6], and remnants of restrictive laws persist, such as Articles 2 and 5 of Ministerial Diploma No. 78/92 [49]. The Mozambican Constitution affirms equality before the law (Article 35) and the right to health and culture. However, ambiguity in existing norms sometimes leaves traditional healers vulnerable to accusations ranging from unlicensed practice to public health threats [42]. Grave infractions—such as trafficking in body parts—are crimes regardless of profession and are punishable under Penal Code Articles 160 and 165, as well as Law No. 6/2008 [50]. Notably, international policy trends, including the WHO’s Global Traditional Medicine Summit (2023) and relevant WHO primary-care declarations, support the regulated inclusion of traditional healing in primary care systems, particularly in under-resourced areas. The country’s legal environment is evolving, but attaining full legal dignity for traditional healers remains an ongoing process.

Traditional healers provide vital services, often more culturally aligned and accessible than formal health facilities, especially in rural areas [41]. Their greater relevance in rural areas stems from factors such as limited access to the National Health System, weaker influence of repressive law enforcement or religious bias, and more culturally homogenous communities compared to urban settings. Rural consultations often occur in the patient’s home or a communal space, with extended interaction, family participation, and the integration of spiritual rituals alongside plant-based remedies. Biomedical facilities, by contrast, offer shorter, standardized consultations guided by diagnostic protocols. For example, a healer treating infertility might combine herbal preparations with divination to address perceived spiritual causes, while a biomedical practitioner would focus on physiological testing and pharmaceuticals. These differences highlight distinct therapeutic approaches and underlying conceptions of illness and healing.

As foreshadowed in the introduction, a related dimension concerns the severity of illness. Little is known about how the severity of illness influences patients’ choice between traditional healing and biomedical care in Mozambique. As Audet et al. [6] and Fleming [51] mentioned, specific programs, such as HIV/AIDS, explicitly encourage healers to refer clients with complications to the SNS, which suggests that mild cases may remain within their domain. At the same time, there are accounts—some anecdotal—of patients turning to traditional healers after biomedical interventions have failed, with reported improvements. These contrasting situations make it difficult to generalize, and a definitive understanding would require targeted research comparing outcomes across severity levels and conditions.

While the appeal of traditional healing indeed rests on trust, cultural resonance, and spiritual legitimacy, there is also a tangible economic dimension underpinning its continued use. For many people—especially in underserved areas—traditional healing often costs less or is paid only upon perceived effectiveness, making it an economically viable option compared to more consistently fee-based biomedical consultations [52,53,54]. Furthermore, traditional practitioners have played economically significant roles in public health, for example, by improving ART adherence in rural Mozambique when engaged as community support partners [55].

The work of traditional healers is grounded in ancestral knowledge and community trust, making them essential actors in health promotion and social cohesion; thus, it may be a matter of both moral and legal responsibility. Justice demands not only tolerance but active respect for this role. The restriction of healers’ autonomy—through underregulating or legal ambiguity—prevents them from fully participating in sustainable development initiatives. Respecting the moral agency of traditional healers involves acknowledging their distinct worldview, including notions of sacredness, without reducing them to “primitive” caricatures. The goal is not to eradicate mysticism, but to foster transparent and ethical dialogue about standards of care, ensuring protection for both practitioners and patients. In a democratic society, the population’s right to choose their health providers—if informed and protected—should shape policy. Revisiting laws such as the 1992 Ministerial Diploma [56] is warranted. The balance between sacred values and procedural transparency should be negotiated between the population and traditional healers, except in cases where the practice constitutes a threat to public order.

SNS faces critical human resource shortages, with only 2 doctors per 100,000 people in rural areas [45]. In contrast, over 110,000 traditional healers serve around 80% of the population [27]. From a utilitarian view, their integration is not only logical but necessary to achieve Universal Health Coverage and SDG 3 (Health and Well-being for All). Traditional healers often collaborate with the formal healthcare system, referring patients when appropriate and treating culturally rooted ailments that are often overlooked by biomedicine [39]. However, reciprocity is limited: biomedical professionals rarely refer patients to healers, reflecting a lingering epistemic hierarchy. Stereotypes continue to distort perceptions.

Beyond its role in health provision, traditional healing contributes significantly to socio-economic sustainability in Mozambique and other regions. In many contexts, including South Africa and India, these practices create employment opportunities, generate household income, and stimulate local economies [57,58]. Traditional healers also play crucial roles in public health, disease prevention, and psychological support, especially in areas with limited access to biomedical care [59]. Moreover, they contribute to biodiversity conservation and cultural sustainability by maintaining the knowledge and use of medicinal plants [60,61,62]. However, marginalization, lack of formal recognition, and limited intergenerational knowledge transfer threaten the continuity of these systems [63,64]. Integrating traditional healing into modern healthcare frameworks can enhance community resilience, preserve cultural heritage, and strengthen ecological stewardship, provided that equitable benefit-sharing and safeguards against overexploitation are ensured [59].

Public imagination often casts the healer as either a magician or a witch, figures shaped by Western folklore and inquisition-era prejudice [43,44]. These caricatures ignore the reality of healers who, in many cases, apply accessible, herbal treatments based on generations of empirical knowledge [39]. For instance, among several plants, Jansen et al. [11] wrote about Impatiens walleriana Hook.f, known as mecado, medaco, or manamulungo, used as tea to alleviate pain during pregnancy. For consequentialist ethics, the question is simple: which policy option maximizes public well-being, dignity, and trust? The answer lies in regulated collaboration, mutual respect, and the gradual dismantling of stigma. Exclusion is not only unjust, but also inefficient.

In sum, legal clarity, moral fairness, and public benefit all support the structured emancipation of traditional healing in Mozambique. Rather than privileging one system over another, the ethical imperative is to develop inclusive health policies that reflect the realities and needs of the Mozambican people, while also contributing to planetary health and sustainable development.

9. Thoughts on the Zeitgeist and the Urgency of Emancipation

Traditional healing in Mozambique mirrors realities across sub-Saharan Africa, where Western biomedicine was introduced through colonial structures, marginalizing indigenous knowledge systems. Despite recent reforms, legal and institutional legacies still reflect this hierarchy. Many current restrictions on traditional healers stem from outdated colonial laws, sustained by lingering perceptions of cultural inferiority.

The impact of these structures goes beyond legality—it translates into stigma, where those relying on traditional healing often do so discreetly, and practitioners are treated as informal or inferior. This tension persists. From a utilitarian and equity-based perspective, excluding these practitioners undermines both access to health care and cultural dignity.

The prevailing public discourse still lacks clarity and confidence. An intense dialogue between traditional healers, biomedical professionals, and policymakers is necessary, grounded in mutual respect. This dialogue should not aim to subordinate traditional healing to biomedical standards, but rather to co-create a plural health system where complementary knowledge systems reinforce one another.

Traditional healing is not a residual or desperate option. It is a holistic health system, historically rooted in local ecosystems, social structures, and spiritual worldviews. Recognizing its legitimacy is not only a matter of justice but a strategic step toward building a resilient and inclusive health system capable of addressing the challenges of sustainable development and planetary health.

10. What Are the Tradeoffs of Emancipating Traditional Healing?

The trade-offs of emancipating traditional healing in Mozambique (

Table 4. Potential benefits, risks, and trade-offs of emancipating traditional healing in Mozambique.

Dimension	Potential Benefits	Possible Risks or Trade-Offs
Cultural preservation	Safeguards ancestral knowledge and Mozambican heritage for future generations	Risk of reductionism and loss of a holistic worldview if biomedicalized
Public health access	Expands coverage in underserved areas; complements formal health services	Quality assurance and regulation challenges
Research and innovation	Opens new pathways for plant therapy and integration of AI-based diagnostics	Risk of appropriation without benefit-sharing (biopiracy)
Sustainability	Promotes the use of local biodiversity and resilient practices	Overexploitation of medicinal plants, if not ecologically managed
Social equity	Addresses historical marginalization; recognizes diverse epistemologies	Institutional resistance and operational complexity if poorly integrated

) reflect tensions between recognition and regulation, as well as preservation and transformation. While the documentation and integration of ancestral practices offer a critical opportunity to protect cultural knowledge, doing so within biomedical parameters risks altering the very nature of these systems.

Unlike biomedicine, traditional healing derives much of its coherence from community context, spiritual cosmology, and ecological interdependence—dimensions that are difficult to preserve through purely clinical or laboratory-based frameworks. Attempts to reduce traditional healing into isolated chemical compounds or to formalize it according to standards of mainstream science often strip away the relational and symbolic aspects that communities value most. This biomedicalization, while offering certain advantages in standardization and global credibility, may ultimately disempower the very actors it aims to elevate [65].

At the same time, a laissez-faire approach that leaves traditional healing entirely outside the formal system can exacerbate existing risks. Fraudulent practitioners, misidentified plants, and harmful interventions cannot be ignored. However, over-regulation may alienate healers and communities, pushing practices further into informality or extinction. The middle ground must be carefully negotiated. Emancipation necessitates the development of inclusive, dialogical mechanisms that respect the ontological foundations of traditional healing while providing space for evidence-informed safeguards. That means acknowledging the legitimacy of its knowledge systems and not merely tolerating them as cultural artefacts or stopgap measures for health system failures.

Moreover, the social and political stakes of emancipation extend beyond health. Traditional healing is not only a medical system but a vessel of identity, intergenerational continuity, and sovereignty. As discussed earlier, the challenge here is moving from acknowledgement of that history toward practical mechanisms that address it without compromising the cultural integrity of the system. In this light, investments in educational reform, research infrastructure, and technology transfer—such as the ethical use of artificial intelligence—could reposition traditional healing not as a relic, but as a dynamic contributor to sustainable development and planetary health. National institutions could emulate international initiatives, such as the WHO Global Centre for Traditional Medicine in India [27], while also building on existing local structures, including AMETRAMO and CIDE. However, this process must avoid reproducing a situation in which local knowledge is exploited for commercial or academic gain without equitable returns.

Ultimately, the emancipation of traditional healing will only be meaningful if it arises from within, grounded in the priorities and perspectives of those who practice and rely on it. As Borges [27] notes, traditional healers are already central to public health, particularly in rural Mozambique, where biomedical coverage remains limited. The question is not whether traditional healing should evolve, but how it evolves—and who decides. This is where the trade-offs become political, not just technical or ethical. Navigating them requires a combination of political will, epistemic humility, and a long-term commitment to pluralism.

11. Conclusions

The emancipation of traditional healing represents a significant form of community empowerment, contributing not only to cultural justice but also to the resilience and reach of the national health system. Far from being an alternative reserved for those with limited options, traditional healing in Mozambique already plays a dominant role in healthcare provision, particularly in rural areas. What remains lacking is not widespread adherence, but formal acceptance within the dominant policy and institutional discourse.

The holistic nature of traditional healing—rooted in social, spiritual, and ecological relationships—often clashes with biomedical rationality, generating discomfort and stigma, even among those who rely on it. Yet this discomfort should not translate into marginalization. Individuals retain the right to seek care in ways that reflect their beliefs, cultural identities, and lived realities. Recognizing this plurality is essential to fostering inclusive health systems and upholding the ethical principle of respect for people.

Throughout this reflection, legal, moral, and consequentialist arguments converge in favor of emancipation. To achieve it meaningfully, policymakers must cultivate a space of dialogue where traditional healers, biomedical professionals, and community members can negotiate shared standards while respecting epistemological diversity. This is not merely a technical reform but a political and ethical imperative. Emancipation must not entail the submission of traditional healing under biomedical norms, but rather the mutual recognition of distinct but complementary worldviews.

By dignifying traditional healing as a legitimate pillar of health and well-being, Mozambique affirms its cultural sovereignty while advancing its commitment to the SDGs, particularly Goals 3 (health for all), 10 (reduced inequalities), and 16 (inclusive institutions). Ultimately, promoting epistemic inclusion and cultural self-determination is not only an act of national coherence—it is a pathway to human flourishing and planetary health.